Dumping syndrome

　　The occurrence of dumping syndrome may be related to the following factors:

　　(1) Blood sugar and blood volume: Due to the loss of the pyloric regulatory function after gastrectomy, the residual stomach volume decreases, and the vagotomy affects the relaxation of the stomach after meals, resulting in a large amount of hyperosmotic food residue suddenly entering the duodenum or jejunum. The high osmotic sugar in the intestinal lumen and the extracellular fluid in the intestinal wall rapidly exchange with each other to maintain the osmotic balance between the intestinal contents and the intestinal wall, which can lead to a significant increase in blood sugar, a decrease in blood volume, and intestinal distension.

　　(2) The role of gastrointestinal hormones: Give 220ml of 4.5% glucose solution to patients after gastric resection, and take blood samples at 15 minutes, 60 minutes, and 120 minutes after fasting, respectively. Using radioimmunoassay, vascular dilator activity can be detected in the blood of all patients with dumping syndrome, but not in those without it. Furthermore, the injection of bradykinin into normal people can produce the same vascular response as dumping syndrome. Clinical observations also show that dumping syndrome is closely related to the level of bradykinin in the blood. Vascular dilator activity can increase peripheral blood flow and capillary permeability, and can enhance the contraction of gastrointestinal smooth muscle, thereby causing vasodilation and gastrointestinal symptoms. Therefore, some believe that the occurrence of symptoms in this syndrome is related to the activity of the vascular dilator bradykinin system. Additionally, some believe that the occurrence of this syndrome is also related to the increase in hormones such as vasoactive intestinal peptide (VIP), enteroglucagon, and neurotensin, but no clear conclusions have been obtained.

　　(3) Neuro-psychological factors: Clinical observations have found that patients' preoperative mental state belongs to the excitable or tense type, and it is more likely to develop dumping syndrome after surgery. Neuro-psychological factors can cause pyloric regulatory dysfunction and lead to accelerated gastric emptying, and dumping syndrome can even occur in individuals who have not undergone gastric resection. Therefore, neuro-psychological factors are more important for the occurrence of dumping syndrome.

　　Complications that are easy to cause by dumping syndrome include:

　　1. Dizziness, palpitations, tachycardia, extreme weakness, excessive sweating, trembling, pale or flushed complexion may occur, and in severe cases, there may be a drop in blood pressure and fainting.

　　2. Late dumping syndrome occurs more than half a year after surgery, with symptoms of hypoglycemia appearing 1 to 3 hours after eating, such as weakness, hunger, palpitations, sweating, dizziness, anxiety, and even mental confusion and fainting.

　　The symptoms of dumping syndrome in patients appear during or within 30 minutes after eating, lasting for 15 to 60 minutes, and lying flat after eating can alleviate symptoms. Early postprandial symptom groups mainly include two groups of symptoms: one is gastrointestinal symptoms, the most common being a feeling of fullness after eating a little, followed by discomfort and distension in the upper abdomen, nausea and vomiting, the vomit containing alkaline bile, abdominal colic, increased bowel sounds, diarrhea, and loose stools; the other group is neurocirculatory system symptoms, including palpitations, tachycardia, sweating, dizziness, pallor, fever, weakness, and blood pressure drop.

　　The methods to prevent dumping syndrome include not removing too much of the stomach during surgery, not making the remaining stomach too small, and making the anastomosis size moderate, generally with a width of 4cm being appropriate. After eating, if symptoms occur, lying flat should be done as much as possible, and high-nutrient, easily digestible solid foods should be eaten in small, frequent meals, and avoid sweet, salty, and strong foods and dairy products. Water and liquid foods can be taken between meals but not during meals. Early postoperative symptoms in most patients are relatively mild, and after a period of gastrointestinal adaptation and dietary adjustment, symptoms can disappear or become easier to control.

　　For patients with dumping syndrome, it is recommended to eat less and more often, consume more dry food than soup, limit sugar intake, and prefer high-protein, high-fat, and low-carbohydrate diets. It is necessary to lie down for about half an hour after eating, and develop the habit of drinking water during meals or fasting.

　　For general hypoglycemia attacks, food, sugar water, or intravenous injection of glucose injection can be given.

　　The principles of treatment for dumping syndrome with Western medicine are as follows:

　　Principles of Treatment

　　1. Diet regulation 2. Drug treatment 3. Surgical treatment when necessary

　　Principles of Medication

　　1. This condition is mainly controlled by diet, which is recommended to eat small and frequent meals, consume more dry food than soup, limit sugar intake, and prefer high-protein, high-fat, and low-carbohydrate diets. It is necessary to lie down for half an hour after eating.

　　2. Take atropine or Probenecid half an hour before meals to slow down intestinal peristalsis.

　　3. Take Dacron or Mebendazole or inject insulin half an hour before meals to shorten the duration of hyperglycemia.

　　4. Growth hormone can be tried for severe cases.

　　5. In mild to moderate cases, symptoms can be alleviated or cured after treatment for several months or years. In severe cases, surgical treatment can be considered if treatment for more than two years is ineffective.